What is a CABG?
CABG stands for Coronary Artery Bypass Grafting and you may have recently had this surgery or have it planned for the near future. With the help of the fantastic members of my Healthy Hearties Facebook Group I’ve put together what to expect when you’ve had or are having a CABG. I hope you find it helpful and please do get in touch with any questions or comments you may have about what you have been through.
Firstly, a CABG is a major operation, performed by a specialist heart surgeon and will take several hours. A CABG will require you to stay in hospital for on average 4-7 days. The most common type of CABG is ‘on pump’ which means the heart is stopped with the body’s blood supply being maintained by the cardiopulmonary bypass machine. Sounds scary but the surgeon and their team are very skilled and make the process straightforward, safe and over the years it has become much quicker.
The CABG surgery usually begins with the surgeon harvesting blood vessels from one (or both) of your legs or arms. Often they will have discussed what they prefer and are likely to use so you know beforehand. They can also use vessels from around your heart called the mammary arteries.
Your surgeon gains access to your heart using a midline sternotomy (down the middle of your breastbone). Some surgeons can also access the heart by using a smaller cut under the left armpit and through the ribcage. Don’t worry, during the surgery you won’t know what is happening and will be very groggy for several hours after you wake up.
Will it hurt?
The medical team and anaesthetists will ensure you’ve been given plenty of local anaesthetic and strong pain relief during the operation to control any pain and will be on close watch to make sure you aren’t in too much pain afterwards. When you wake up, if you have pain you can ask the nurses and they can give you quick active medication through your veins. Don’t wait until it is unbearable to ask for pain relief as it will be harder to control. Because of the nature of the surgery and the wound, you may feel quite sore afterwards for several weeks so it’s important to rest, take it easy with movement and exercise, and keep up with regular painkillers until the wound heals and you can start to reduce the pain medication.
Why do I need a CABG?
The purpose of Coronary Artery Bypass Grafting (CABG) is to improve the flow of blood to your heart muscle. Your surgeon will use a section of healthy vein or artery from your arm, leg or chest wall to go beyond (bypass) the narrowed segments of coronary artery and restore normal blood flow to the heart. Think of it like a detour around roadworks due to a car blocking the main road.
What are the benefits of having a CABG?
The main benefits of having a CABG vary a lot but can include:
- Reducing angina (chest pains)
- Increase the amount of physical activity and exercise you are able to do
- Make you feel better and have more energy
- Increase your chance of living longer
- Reduce the amount of medication you take
Can I get new blockages after a CABG?
Bypass surgery will not cure coronary artery disease. It is possible to get new blockages. Sometimes these can be opened up with a small piece of metal called a stent. The best way to reduce the risk of this happening is by stopping smoking, taking the tablets your doctor prescribes, reducing stress, adopting a healthy diet and exercising regularly.
What can I expect after a CABG?
You should expect to have a scar running lengthways from your breastbone to a point on your midriff, of at least 6 inches long. You may also have some small scars where some drains were after the surgery (below the belly button), a wound on your leg if a vein has been removed to make the graft, or an incision in your arm if a vein has been harvested from there. Don’t put any creams on the scar until the scab has completely gone. Until then, unperformed soap (e.g. Dove) and warm water in the shower is fine. Pat dry gently with a clean towel.
If the surgeon has used any stitches (or sometimes clips) which don’t dissolve, then a nurse at your local doctor’s surgery will remove these about 8 to 10 days after the operation. Your surgeon or nurse will advise you exactly when you should have them removed. Wash the stitch sites with plain soap and water and wait until the scab has completely gone before you put cream on the area.
Dressings and wound care
It is common for some of the wounds to leak a small amount of fluid in the days after your operation. Often these can be removed after a few days. If your wound is quite oozy, a district nurse may need to visit you at home to change the dressing for you.Use only soap and water on the affected areas, and keep them clean and dry. You should be able to bathe as normal, but if showering, turn your back to the spray to avoid irritating the wound. Try to use water that is not too hot or cold, and don’t soak or rub the affected areas until they are completely healed.
You’re bound to feel some soreness in your chest immediately after surgery, and you may get pain in the surrounding muscles, such as your neck and arms. This is normal and usually eases off over the 3 to 4 weeks. You may experience discomfort in your chest for a while after the initial healing phase but for most people this will resolve after a few months.
It is important to continue to use your arms during this period as it will help with healing if you keep your muscles strong. Start with simple shoulder shrugs and very gentle stretches for the first 6 weeks after CABG.
Exercises to avoid for the first 12 weeks after CABG
For the first 12 weeks post CABG it’s important to let the bone heal and avoid the following exercises:
- Heavy lifting – the general rule is no more than 5lb/2kg
- Putting pressure on your arms e.g pressups, plank, pushing a wheelbarrow
- Performing activities that put pressure through your chest wound or involve twisting like:
- Swimming (gentle walking/movement through water may be ok once wound fully closed over)
- Contact sports
After this time, start to rebuild your upper body strength gradually. Perform exercises that feel comfortable and slowly over the coming months make things harder.
Try to attend Cardiac Rehab as soon as it becomes available to you as this will give you the knowledge and confidence to rebuild your strength safely after CABG. If you haven’t had access to cardiac rehab, get in touch with me HERE and I can put together a personalised programme for you.
If a vein has been removed from your leg, you will also have some swelling there, and some patients get pins and needles, or numbness. Listen to your body and if something hurts, stop and wait a few more days/weeks before retrying. It is better to take regular painkillers throughout the day then to wait until the pain worsens, as it is then more difficult to manage. Paracetemol is usually enough but check with your doctor if you are unsure.
Patients commonly report after a bypass operation that they have strange, vivid and often scary dreams. It is unclear why this occurs but it is thought to do with the length of the operation, combined with the anaesthetic and the use of the bypass machine. Unfortunately there is no prevention however know that they will soon become less frequent and stop occurring completely in a few months. You may find that you need to take a sleeping tablet for a few months. Please talk to your doctor if it is making you feel down, depressed, anxious or exhausted.
Your body is using a lot of energy to heal itself, so you will feel more tired than normal – sometimes it can come upon you suddenly but don’t feel that it’s going to be that way forever. As your physical activity levels improve you will steadily start to feel less tired. Take regular rests and don’t overdo it – now is not the time to get on top of the DIY list! Taking a 30 minute nap in the afternoon for a few weeks is normal and can really help you to get through the day.
If you feel upset or emotional in the days and weeks after your operation, don’t worry – this is a perfectly normal reaction which many people experience. Talk to your doctor if your mood remains low or your appetite does not return after a couple of weeks. If you feel depressed, you are not alone. There is support available. Please talk to your GP, partner, friends or family member if you feel low, anxious, irritable or are struggling. There are some fantastic support groups online out there now. Please come and chat to us at Healthy Hearties and know that you are never alone in this. During my 12 week programmes people often say that having someone who understands what they’ve been through has been one of the most helpful aspects of my programme.
Questions or comments? Need help?
I’m here to answer your questions about what to expect after a CABG. I am a cardiac nurse and exercise coach and help people to get their confidence back and recover after a major heart operation like a CABG. I help people through my face to face programmes (in East Molesey), online programmes (from anywhere in the world) and my group exercise classes in the Healthy Hearties Inner Circle. Please do get in touch HERE to find out more and get your fitness, energy and spark back!